big corporations in vet industry

[pinkpuppy9]

Here it is... veterinary mid-levels. And they'll get even less training than a CVT/RVT/LVT... but can supposedly diagnose and do minor surgeries.

Welcome to the new vet med, where DVMs aren't hired as much and are replaced by the mid-levels but the cost remains the same and the DVMs that are hired have full clinical responsibility for the mid-levels. Good luck protecting your license.

Master of Veterinary Clinical Care


I'm honestly more concerned for finding care for my own pet now that I'm really not in clinical medicine. It'll turn into human medicine where you can't actually see a Dr anymore. Rather sad. This will put animals at risk and there will be many more medical deaths.

Sounds similar to a physician's assistant (a role I never really understood the reasoning/need for, to be honest) - some of the perks of a doctor, but often without the same level of responsibility or years of schooling if I am correct in my understanding of a PA.

Coming from an ER perspective - I could see someone like this running the 'urgent care' portion of my ER that we are trying to establish. The things that make people like me roll my eyes when we get a triage call for them - itchy dogs, ear infections, non-complicated eye issues, kitten URIs, vomiting episode in an otherwise excessively BAR puppy, etc. Things that don't need a workup or serious assessment of labs/diagnostics, things that wait 6 hours to be seen because I got sicker pets to deal with. I mean, the last time I went to an urgent care, I didn't see a doctor.

At the same time, would someone who did this program want a job in ER? Where else would someone like this fit in? Honest questions - this program is starting up regardless. I don't see any info on their website stating 'A graduate of this program can fill x void in a practice....' for example. Perhaps the graduates of this program would fill the growing ER telemedicine niche? I truly have no idea. I just don't see a need for someone like this in general practice, but most of you would have better opinions on that than I do.

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[battie]

I'll second @Trilt where I feel overall that the average vet student is ready to go day 1 overall, despite the confidence level the graduates have. There were plenty of opportunities for students to get experience within and outside of the curriculum for my class. And my clinical year was during corona where I had 4 months worth of clinics online. If students wanted the experience, it was there. They just had to go find it.

I was that bare minimum student to a certain extent. I repeated 1st year. Almost failed out 2nd year following a catastrophic family event. I'm over 6 months out now and have had no more issues with learning as the other new grad in my hospital. I already have a solid client base that requests me specifically. No one could tell I was literally bottom of my class. If anyone was going to be ill prepared for day 1 practice, it would have been me. Here I am though, literally rocking it from every possible metric my hospital could ask or me.

 

[battie]

I just don't see a need for someone like this in general practice, but most of you would have better opinions on that than I do.

I don't feel it's a necessary position in GP either. These folks would get stuck at the same bottle neck I do: the lacking in support staff. We absolutely needed 3 more techs today to be able to run efficiently. We had 1 doctor in surgery, 1 in dental, 1 ER, 1 sick appointments, and 3 general practice appointments. Between the 7 of us, we had 6-8 techs at any on time. I understand we're actually pretty lucky to have a 1:1 ratio overall, but when you have 1 tech in surg, 1 in dental, 1 doing tech appts, you suddenly have the 5 docs doing er and appointments sharing as few as 4 techs, we get behind.

We need more techs. Short stop.

 

[DVMDream]

Coming from an ER perspective - I could see someone like this running the 'urgent care' portion of my ER that we are trying to establish. The things that make people like me roll my eyes when we get a triage call for them - itchy dogs, ear infections, non-complicated eye issues, kitten URIs, vomiting episode in an otherwise excessively BAR puppy, etc. Things that don't need a workup or serious assessment of labs/diagnostics, things that wait 6 hours to be seen because I got sicker pets to deal with. I mean, the last time I went to an urgent care, I didn't see a doctor.

I disagree with this. I don't think they are able to handle these cases. This is how they infiltrated human medicine "well they will help you with those mundane, routine cases you see and ease that burden for you." Then it blew up to them now demanding (and often getting) practicing capabilities with varying degrees of actual "responsibility" for the cases they do see. In most cases the case responsibility is dumped onto the MD/DO that is "supervising" them. I am in a group of MDs/DOs/DVMs and this is being discussed and the resounding response from the MDs/DOs is that we need to fight against this very, very hard. Do NOT allow them to do this if at all possible. They don't go after PA/NP licenses because there is limited liability ($$$ to be reimbursed) if a medical error is created by the PA/NP, they go after the supervising MD/DO (regardless of if this person even touched the patient or was physically in the building/involved with patient care). It won't decrease your work load, it will increase it, you will have to manage/treat all those "really sick" pets and rubber stamp off that you agree with the care your veterinary NP/PA equivalent provided to these cases, regardless of if you even put hands on the pet or not. You just have to hope they asked the right questions, did a detailed exam and did the correct diagnostics. Then you have to worry not only that any case you managed could get sent to the board, but also any case your PA/NP managed could get sent there on your license.

The thing is, you should have seen a doctor when you last went to urgent care.

The last time I went to the ER, I also didn't see a Dr. It is bull****. I google scholared some of the things he was telling me and they weren't very accurate at all. Things like "if x is normal it means you can't have a pulmonary embolism", when the reality is, it is much, much more gray zone than that.

But they aren't taught that in PA/NP school. They are taught algorithms and how to follow the same ducking pattern for every single patient. They often don't get enough phamarcology to know how the medications work with physiology let alone what medications might interact with each other.

It is is a bad go, and I strongly disagree that they can manage this "minor" stuff, nor should we settle for anything less than doctors doing the job of a doctor. If people want to practice medicine (for humans or animals) go to medical school. Period. Go the full way or be happy doing the job of a nurse or vet tech.

 

[TheDogFather]

I mean, I can only speak for my school, but between the teaching and opportunities I was able to arrange I felt very adequate going into practice as a GP. My bosses never complained about me, lol. I transitioned easily to ER medicine after a couple of years, and while a lot of that was self taught and motivated, I feel like I had a good base from school despite being a fairly crappy student.

I specifically have worked in practices slightly outside of large urban areas because I enjoy the "jack of all trades, master of none" component of veterinary medicine and *not* referring everything. While our professors obviously always recommended offering gold standard, referral level care, with only some exceptions they were also enthusiastic about saying that we could handle way more than we thought and that often we were the only doc for that pet.

For your specific examples: I wasn't certain if I'd have ultrasound in practice so didn't seek out ultrasound opportunities, but we had an ultrasound rotation with the radiologists, did FAST scan stuff on ER, and they routinely had ultrasound training courses for GPs in the area that student pets were used for that we could hang out at as much as we wanted. We also had a fab terminal surgery lab (on pigs) where we did gastrotomy, enterotomy, splenectomy, etc. I had lots of opportunities to arrange spay/neuter experience in the area with a local rescue and with our mobile unit, then had space in my fourth year to get humane alliance trained and spend more time with another shelter... I had done over a hundred surgeries at graduation. Obviously mostly spay/neuter, but a spattering of others, too.

I'm rambling a bit, but my point is that I think you might be slightly more doom and gloom about available opportunities in schools for people who are interested in them. My goal was always to graduate as a reasonably competent vet at d1, and I think I was very much able to do that with my school.

From one fairly....no, really crappy student to a fairly crappy one: I don't know when you graduated, but your experience was much more hands-on than mine. I'll concede that there are more chances to gain surgical experience. Shelter rotations and spay/neuter externships were just getting off the ground when I graduated. Still, I was one of those "two neuters, a spay-and-a-half, and one declaw" students in terms of actual surgery, but I sure spent more than my fair share of time cleaning cages and filling in the blanks on canned surgery reports. Even though the school had an older backup ultrasound machine, none of us every touched it. No FAST scans. No one but residents and ophthalmologists were allowed to touch the slit-lamp biomicroscope. Like you, I was attracted by the supposed versatility of our training. I worked in large shelters and small-city vet clinics because. again like you, I figured I didn't pay what I did to memorize parasite life cycles, push flea preventatives, squeeze anal sacs, and tell people that this fracture requires referral, amputation, or euthanization. I don't think its so much gloom and doom as at was poor bang for the educational buck.

 

[that redhead]

Re: mid-levels, I feel that one of the biggest difference is that in human med, many medical students seem to see family med/equivalent of GP as bottom of the barrel, least-desirable in terms of landing place. I’ve seen people lament that if they take a rural family med position, they “only” make 200k starting out. Whereas the more competitive specialities are making tons of money when they finish jumping through all of the hoops, plus the prestige of calling oneself an orthopedist or plastic surgeon or whatever it is. It is also my perception that a lot of foreign grads end up filling in the family med positions, furthering the “least sexy” vibe.

I have no idea if there is a “shortage” of family med practitioners on the human side of things. (@Roxas @VA Hopeful Dr maybe could chime in?) But perhaps that’s why it’s been so easy for mid-levels to proliferate there? I agree that in vet med, there isn’t really a hole for these people to fill, at least competently/ethically, that I can see.

 

[VA Hopeful Dr]

Re: mid-levels, I feel that one of the biggest difference is that in human med, many medical students seem to see family med/equivalent of GP as bottom of the barrel, least-desirable in terms of landing place. I’ve seen people lament that if they take a rural family med position, they “only” make 200k starting out. Whereas the more competitive specialities are making tons of money when they finish jumping through all of the hoops, plus the prestige of calling oneself an orthopedist or plastic surgeon or whatever it is. It is also my perception that a lot of foreign grads end up filling in the family med positions, furthering the “least sexy” vibe.

I have no idea if there is a “shortage” of family med practitioners on the human side of things. (@Roxas @VA Hopeful Dr maybe could chime in?) But perhaps that’s why it’s been so easy for mid-levels to proliferate there? I agree that in vet med, there isn’t really a hole for these people to fill, at least competently/ethically, that I can see.

Its complicated. I'll try and simplify since I don't imagine y'all want multiple pages on the intricacies of the business of human medicine.

There's basically two reasons we have midlevels at the primary care level: access and money.

Money is the easier one: midlevels can bill for usually around 80% of what physicians can (Medicare rules) but are paid way less than 80% of what we are. So whoever owns the practice makes more money off of them than they do off of us.

Access is trickier. There's debate as to whether or not there is a shortage of FPs. There is definitely some aspect of a distribution issue. In my neck of the woods, a new patient can usually find primary care within 2-4 weeks. Go 3 counties over and its 8-12 weeks. But even 2-4 weeks isn't ideal so I think there is also some degree of shortage. It also takes around 12-18 months from start to finish to recruit a new FP to any given location. Midlevels take 1-2 months to find. We just hired a new NP for our practice to replace one who left, from posting the job to her first day of work was I think 6 weeks.

If I'm being honest, I think the money aspect is the driving factor here. It almost always is.

 

[CalliopeDVM]

in human med, many medical students seem to see family med/equivalent of GP as bottom of the barrel, least-desirable in terms of landing place.

That's true for vet med as well --- maybe not as many vet students as med students, but there is a sizable percentage of vet students who see being a GP vet as least-desirable and definitely "less sexy".

 

[battie]

That's true for vet med as well --- maybe not as many vet students as med students, but there is a sizable percentage of vet students who see being a GP vet as least-desirable and definitely "less sexy".

Agreed. But I think it's less of a driver since so many people end up in GP due to the impossibility of everyone specializing. Even the hard-core people who try to specialize frequently get left behind. We have a guy on his second round to get a surgical residency

 

[that redhead]

That's true for vet med as well --- maybe not as many vet students as med students, but there is a sizable percentage of vet students who see being a GP vet as least-desirable and definitely "less sexy".

Sure, specialization is becoming a lot more popular and sought-after. However, anyone can fall back on GP work whereas in human medicine, you’re pigeon-holed and can’t just change specialities or go back to GP work. So I don’t think that has as much of an influence.

 

[DVMDream]

That's true for vet med as well --- maybe not as many vet students as med students, but there is a sizable percentage of vet students who see being a GP vet as least-desirable and definitely "less sexy".

I'd still say at least 60% of veterinary students are really just aiming for small animal GP, certainly specializing is getting more popular, but the vast majority are still looking to be the common "family" small animal veterinarian. Going to be really hard to tell GP vets to stop doing the job they want to do. I am not in GP anymore, but when I was, I wanted that position because I wanted to do the routine wellness exams, vaccines, etc. I wanted to build relationships with clients and see their pets from puppy/kitten-->adulthood--->senior/end of life. I wanted that. So expecting the vast majority of a profession to give up what they were wanting to do so a lesser trained NP/PA version can do it is going to be a hard sell (hopefully). Most GPs don't want to hang about to see only the really sick cases, there is a reason that it takes a certain "breed" of vet to do ER, because non-stop seeing only sick pets is different than what happens over on the GP side.

 

[aspiringvet54]

Lol got this email and remembered reading the discussion of mid-level professionals in vet med On here

 

[battie]

View attachment 349307
Lol got this email and remembered reading the discussion of mid-level professionals in vet med On here

Guess I'm emailing the CVMA tomorrow to voice my strong opposition to this

 

[BlueCats]

I think it’s a mixed bag. I’ve worked for both as a CVT, now going to vet school. Corporate practices do whatever will maximize profits which I think is terrible for the industry as a whole. On a personal level, I have worked in good and bad corporate and private practices.

Vet med would benefit from more standardized care, like doing away with OTJ trained “techs” being the norm in many places. I think corperate has the means to shift in this direction. However, I don’t think that they will. It’s sad that what was once the most entrepreneurial degree is rapidly changing because of huge corporations who don’t even have roots in healthcare, like Mars.

 

[aspiringvet54]

View attachment 349307
Lol got this email and remembered reading the discussion of mid-level professionals in vet med On here

 

[aspiringvet54]

CVMA | CVMA releases position statement on the veterinary professional associate (mid-level practitioner) proposal


That’s the article for anyone interested in reading!

 

[battie]

I appreciate that they actually took our input to heart.

 

[Iamnew2]

They *can* pay more, but don't always. From my perspective, corporations (or maybe just my corporation...) are driving up the costs of care while driving down wages for non-DVM staff across the country. Big companies can attract people with the big sign-on bonuses, but their turnover is going to end up being high once those contracts expire. It feels good to get $5,000 until you realize you are getting your ass handed to you daily for $15/hr.

My company in particular (we are already the most expensive place in town) raises prices at least 1-2x/year with no subsequent pay raises for hourly or straight-salary DVM staff. We are hemorrhaging nurses, and some of my best, most capable nurses are leaving the field entirely (with some actually studying to go into human nursing).

Corporate has pros and cons. I had a huge long posted typed out, came back today, and thought I had posted it and it is gone lol. It really depends on which company you are looking at, and also what position you will have. Sometimes it also depends on what location you are at within that company. For example, my company pays ER doctors on production in some areas, in other areas like mine we are on straight-salary.

We are losing capable nurses so fast that we are hiring anyone with a pulse to work in our ER/ICU. Because of this, I currently am dealing with a case that may or may not result in a board complaint - new nurse ignored my dilution instructions and went rogue, and the patient may or may not have ben fluid overloaded as a result (may or may not, because I can't definitively say for sure). Nurse later that night also was not appropriately monitoring the dog, so we don't even know when things went downhill for sure. I had no hand in hiring or training these nurses or determining whether or not they could handle our arguably most difficult positions (ER and ICU). Yet, I'm the one whose license and professional reputation may get trashed

A benefit of corporation in situations like this is I basically just sit and wait now - it's out of my hands. They have lawyers on retainer for this. If my high up management can't smooth this over and make this disappear, then I've got big lawyers ready to take over. All with me doing nothing but waiting (and stressing...).

What are vets making these days? I hear both good and bad in terms of salaries, some vet friends say they pay is paltry and the emotional aspect of taking care of animals is huge, while some say they do well financially. Corporate medicine is here to stay - both in human and non-human medicine.

 

[Iamnew2]

Re: mid-levels, I feel that one of the biggest difference is that in human med, many medical students seem to see family med/equivalent of GP as bottom of the barrel, least-desirable in terms of landing place. I’ve seen people lament that if they take a rural family med position, they “only” make 200k starting out. Whereas the more competitive specialities are making tons of money when they finish jumping through all of the hoops, plus the prestige of calling oneself an orthopedist or plastic surgeon or whatever it is. It is also my perception that a lot of foreign grads end up filling in the family med positions, furthering the “least sexy” vibe.

I have no idea if there is a “shortage” of family med practitioners on the human side of things. (@Roxas @VA Hopeful Dr maybe could chime in?) But perhaps that’s why it’s been so easy for mid-levels to proliferate there? I agree that in vet med, there isn’t really a hole for these people to fill, at least competently/ethically, that I can see.

200k is paltry for human medicine, reason why no one wants to do primary care. Unlike vets, human doctors do 4 years of med school, residency, frequently fellowship - we can't just go to med school and start practicing. I dont know what vets make starting out but there is no point in just making 200k after all these years of work. reason why primary care is bottom of the barrel.

 

[SnowJ]

What are vets making these days? I hear both good and bad in terms of salaries, some vet friends say they pay is paltry and the emotional aspect of taking care of animals is huge, while some say they do well financially. Corporate medicine is here to stay - both in human and non-human medicine.

This varies massively depending on your specialty/practice type and location. Where I live new grads can expect to make 85-100k right after school going into small animal general practice. Large animal vets tend to have lower salaries due to rural location, unless they are working for a big corporate producer. Specialists usually make more, but academia makes less than private practice in general.
These are broad statements and it varies a lot, but anywhere from 50-150 base salary is a range for private general practice, with specialists being able to get up to 200k or more. Most places have production on top of base salary as well

 

[JaynaAli]

200k is paltry for human medicine, reason why no one wants to do primary care. Unlike vets, human doctors do 4 years of med school, residency, frequently fellowship - we can't just go to med school and start practicing. I dont know what vets make starting out but there is no point in just making 200k after all these years of work. reason why primary care is bottom of the barrel.

Board certified veterinary pathologist here. I went to four years of vet school, a one year internship, and a three year residency. My first job as a boarded specialist paid $113,000. I make more now but still under $200,000 and EXACTLY like Med school it took 11 years of higher education.

 

[KCgophervet]

200k is paltry for human medicine, reason why no one wants to do primary care. Unlike vets, human doctors do 4 years of med school, residency, frequently fellowship - we can't just go to med school and start practicing. I dont know what vets make starting out but there is no point in just making 200k after all these years of work. reason why primary care is bottom of the barrel.

My dude, maybe reread what you write before you post because this post reeks of disdain for the veterinarians in the room... in a veterinary thread.

I also had 3 years of a residency following 4 years of veterinary school and my first job post-residency started at $100K. "There is no point" okay well then when food chains crumble and biomedical research grinds to a halt and no one can get veterinary medical care for their pet because "there wasn't any point making less than 200K"...

 

[Iamnew2]

My dude, maybe reread what you write before you post because this post reeks of disdain for the veterinarians in the room... in a veterinary thread.

I also had 3 years of a residency following 4 years of veterinary school and my first job post-residency started at $100K. "There is no point" okay well then when food chains crumble and biomedical research grinds to a halt and no one can get veterinary medical care for their pet because "there wasn't any point making less than 200K"...

Well perhaps you are a specialist vet but most vets don’t have residency afterwards they go from vet school to practice. Specialist vets that’s a different story.I was simply responding to someone who inquired why we human doctors think 200k is paltry and why no one wants to do primary care. Not trying to offend anyone so sorry if that’s how it came across but ok I’m going back to my side of the pond now.

 

[battie]

What are vets making these days? I hear both good and bad in terms of salaries, some vet friends say they pay is paltry and the emotional aspect of taking care of animals is huge, while some say they do well financially. Corporate medicine is here to stay - both in human and non-human medicine.

New grad living in Denver making 90k base with 20% production on most things. My original loan amount was supposed to be 282k, but I have less because I was the beneficiary of my sister's life insurance policies when she died while I was in vet school. I pay all the major bills in the house and it will take 16 years and 4 months to pay off my loans.

 

[that redhead]

200k is paltry for human medicine, reason why no one wants to do primary care. Unlike vets, human doctors do 4 years of med school, residency, frequently fellowship - we can't just go to med school and start practicing. I dont know what vets make starting out but there is no point in just making 200k after all these years of work. reason why primary care is bottom of the barrel.

I understand the differences, with years and years on these forums contributing to that understanding I believe med schools are generally more expensive compared to vet schools as well, although I certainly haven’t researched that in any depth. So I can totally see where you’d pooh-pooh $200k. Just put it in context though.